Provider Demographics
NPI:1003306648
Name:SWIFT, DON RUSSELL (LMT)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:RUSSELL
Last Name:SWIFT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:RUSS
Other - Middle Name:
Other - Last Name:SWIFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4205 W 94TH TER
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2715
Mailing Address - Country:US
Mailing Address - Phone:913-730-7507
Mailing Address - Fax:913-730-7503
Practice Address - Street 1:4205 W 94TH TER
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2715
Practice Address - Country:US
Practice Address - Phone:913-730-7507
Practice Address - Fax:913-730-7503
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017040934225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017040934OtherMISSOURI BOARD OF THERAPEUTIC MASSAGE